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Hepatocellular Carcinoma

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After a long stint with Cirrhosis (Alcoholic), I have been diagnosed with Primary Hepatocellular Carcinoma (HCC). Detection was through a regular screen and is quite early.

I have four questions.

1. Does anyone have familiarity with this problem and know of veterans or non-veterans support groups that can help me navigate the whole business of treatment, transplants, etc.? This group was invaluable when I was working with the VA to get disability benefits and I'm wondering if there isn't something like this for my current situation...

2. I am currently 100% disabled via TDIU with an underlying rating of 80% due to PTSD with alcoholism (in remission), Depression and Anxiety, Diabetes II (Agent Orange presumptive), and a few other more minor problems (e.g. hearing loss). Does it make sense for me to file a claim to add the HCC to the list and perhaps move 100% on basic rating? Are there some benefits I would get that I'm not currently getting? (Including survivor benefits)

3. I know the VA healthcare system does do transplants. Does anyone have familiarity with this process? What transplant criteria do they use?

4. Is anyone aware of any research studies or clinical trials underway that look at the effect of Agent Orange on the onset of liver cancer?

I'm just looking for information and anything would be helpful.

Thanks

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By any chance do you have aortic valve problems?  The reason I ask my husband just passed away.  And were you taking Sertraline/Zoloft.  My husband was put on Sertraline when he told doctor he thought he had ptsd and had had it since vietnam. He got out in 68, went on police dept in St. Louis.  That was during all the racial up rise in 60s and 70s. I’m sure he did have ptsd due to both jobs, but he had never been treated for it.  So the dr gave him Sertraline and about two weeks into taking it he had a seizure.  So the doc took him off it.  They did a liver enzymes, which came back really bad. I assumed it was Sertraline reaction.  I’m still trying to put two and two and come with something that caused his death so quickly.  Doctors did not tell me anything.  On death cert it says alcolic cirrhosis, heptocellular carcinoma, multi organ failure..  in 1979 he was diagnosised with histoplasmosis in his eye. So I was reading about that and I saw where it can cause heptocellular problems I kept reading that it can be linked to arotic valve disease, and high blood pressure.  I’m just trying to figure all this out and was wondering if you might have similar issues.  Histoplasmosis is caused by bird droppings and bats I think. I’m going to go back and read all that again.    Good luck with your situation.

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1.   Family members go to AA, and its good for them.

    While this may sound kind of cruel, I did go through this with my brother, who died of liver disease due to alcoholism.      As far as a liver transplant, my wife, a retired nurse, indicates that "they dont do liver transplants for alcoholics".  I guess I can see that, while one life is as important as another, it does make some sense that liver disease, from alcoholism, is "self inflicted", and probably wont be a priority over someone who got a liver disease from conditions "other than" their own choices.     There are probably still not enough transplant organs to go around, and there is careful screening for those who get them.   A big part of this is if they ruined their first liver with alcohol, would that increase the chances they also ruined the second liver?    Please dont take my word for this, ask your doctor, as this information is probably dated and may not be accurate.  

2.  I can see at least 2 instance where you would benefit by seeking additional benefits to include HCC.  

      a).  Survivors benefits.  Specifically, DIC requires one of these.  You have to either die of a "service connected condition" or for any reason after you have been p and t for 10 years.  If you have been p and t for 10 years this may not matter.  

      b). SMC.  Remember, 100 percent is not the "top rating".  Instead, its something like SMC R2 or close.  If additional awards or disabiliity increase could/would result in a "single 100 percent rating" plus an additional combined 60 percent rating", that would be about another $450 per month for you and your family.  (SMC S, statuatory)

      If "a" and "b" dont apply to you, and, it wont benefit your family (see item "a") , then there may not be a good reason to seek additional benefits.  That is, if it would not result in SMC S, and it would not change your family's DIC eligibiiity, then I would not do it.  

3.   See my answer in number 1.  Perhaps others can answer, but you may not qualify for a liver because of reasons already stated.  But, again, dont take my word for it, ask your doctor.  He should be much more up on this than I am.  

4.  Here is a study which apparently links Agent Orange to at least one kind of cancer:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880785/

Also, your liver cancer "could be" a presumptive for AO.  https://www.veterans.nd.gov/sites/www/files/documents/resource/Presumptive Cancers Due to Agent Orange Exposure.pdf

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Wow.

2. I am currently 100% disabled via TDIU with an underlying rating of 80% due to PTSD with alcoholism (in remission), Depression and Anxiety, Diabetes II (Agent Orange presumptive), and a few other more minor problems (e.g. hearing loss). Does it make sense for me to file a claim to add the HCC to the list and perhaps move 100% on basic rating? Are there some benefits I would get that I'm not currently getting? (Including survivor benefits)

First, had you ever attempted to service connect the liver cirrhosis ? What was the result ?

While it might be totally obvious to you, do you have evidence or a medical opinion stating that the EtOH abuse is/was caused by your mental disorder? You need to have this.

Again while it might be totally obvious to you, do you have a medical opinion or evidence in your records that the CA is/was caused by or a result of the cirrhosis? You need to have this as well.

WRT any additional financial benefits to be had if the HCC becomes service connected .... well, yes.

If service connected, during the duration when you have the active cancer, you are eligible for a single 100% based on Diagnostic Code (DC) 7343 at 38 CFR 4.114 http://www.benefits....ART4/S4_114.DOC . This single 100% plus your other disabilities should qualify you for Special Monthly Compensation-s (SMC-s) at 38 CFR 3.350(i)(1) http://www.benefits....0.DOC . Note: you will keep the SMC-k as well.

When you have the liver transplant, you will be evaluated under DC 7351. A 100% evaluation is warranted for <at least> a year post-surgery. You will still qualify for SMC-s and SMC-k.

WRT survivor's benefits ... Bluntly speaking, you are far more likely to pass from either the HCC or the sequelae of the transplant than anything else. A service connected death is "better" than your dependents qualifying for DIC because of the total-disability-for-10-year rule because there is a <somewhat> greater death benefit.

Again, wow.

After a long stint with Cirrhosis (Alcoholic), I have been diagnosed with Primary Hepatocellular Carcinoma (HCC). Detection was through a regular screen and is quite early.

I have four questions.

1. Does anyone have familiarity with this problem and know of veterans or non-veterans support groups that can help me navigate the whole business of treatment, transplants, etc.? This group was invaluable when I was working with the VA to get disability benefits and I'm wondering if there isn't something like this for my current situation...

2. I am currently 100% disabled via TDIU with an underlying rating of 80% due to PTSD with alcoholism (in remission), Depression and Anxiety, Diabetes II (Agent Orange presumptive), and a few other more minor problems (e.g. hearing loss). Does it make sense for me to file a claim to add the HCC to the list and perhaps move 100% on basic rating? Are there some benefits I would get that I'm not currently getting? (Including survivor benefits)

3. I know the VA healthcare system does do transplants. Does anyone have familiarity with this process? What transplant criteria do they use?

4. Is anyone aware of any research studies or clinical trials underway that look at the effect of Agent Orange on the onset of liver cancer?

I'm just looking for information and anything would be helpful.

Thanks

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Thanks for your response.

I have not applied for service-connected Cirrhosis. There didn't seem to be any point as I was at 100% with the TDIU.

I do have a letter that ties my alcoholism to PTSD. Moreover, my rating letter cites "Service connection for post traumatic stress disorder with secondary depression,

anxiety, and alcohol dependence" The Cirrhosis has been diagnosed as Alcoholic Cirrhosis, so I think the chain is there.

I do not have a letter that ties the CA to the Cirrhosis, but can get one fairly easily, I think.

Thanks for the info on benefits, I will follow up. At this stage, the CA is treatable with Trans-catheter Arterial Chemo-embolization which is a localized chemo that should kill or shrink the relatively small lesions that I have. The plan is that this treatment will be a 'bridge to transplant'.

Thanks again for your help.

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Sorry about the delayed response ... the warden only allows me a certain amount of internet time.

Anyway, I understand. However, it is sometime better (whatever better means to you) to get sumpin' service connected (whether on a direct service connection or perhaps a secondary basis) "just in case", even if there will be no immediate increase in financial benefits. Yes, you might go through some administrative agony with no immediate benefit, but the S/C would have been established.

And, in your situation, you might have qualified for a scheduler 100% if a separate evaluation for cirrhosis was added (if that is what you're seeking). Again, no immediate benefit, but ...

Well, good luck with chemo.

After a long stint with Cirrhosis (Alcoholic), I have been diagnosed with Primary Hepatocellular Carcinoma (HCC). Detection was through a regular screen and is quite early.

I have four questions.

1. Does anyone have familiarity with this problem and know of veterans or non-veterans support groups that can help me navigate the whole business of treatment, transplants, etc.? This group was invaluable when I was working with the VA to get disability benefits and I'm wondering if there isn't something like this for my current situation...

2. I am currently 100% disabled via TDIU with an underlying rating of 80% due to PTSD with alcoholism (in remission), Depression and Anxiety, Diabetes II (Agent Orange presumptive), and a few other more minor problems (e.g. hearing loss). Does it make sense for me to file a claim to add the HCC to the list and perhaps move 100% on basic rating? Are there some benefits I would get that I'm not currently getting? (Including survivor benefits)

3. I know the VA healthcare system does do transplants. Does anyone have familiarity with this process? What transplant criteria do they use?

4. Is anyone aware of any research studies or clinical trials underway that look at the effect of Agent Orange on the onset of liver cancer?

I'm just looking for information and anything would be helpful.

Thanks

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